A Medical Perspective
Karunaratne and Somaratne were two patients of around the same age who were admitted to hospital on the same day. Both had suffered heart attacks. Karunaratne died soon after admission. The other went home a week later having made a full recovery.
Both of them received the same treatment but the outcomes were so different. Though this type of incidents are not unusual to us as doctors, they have always puzzled me.
But that doesn’t seem to be the case with Sugathadasa, who is an uncle of Karunaratne. He had a very simple explanation for his nephew’s death - it was his Karma or Karumaya in Sugathadasa’s own words as told to me.
I learned about Karma in Sunday Dhamma school when I was a kid, but I cannot remember my being taught of Karma as a cause of death after a heart attack, in medical school.
When we see phenomena like this in day to day practice, our habit as doctors is to offer some explanation compatible with the medical science we know of. For example in this case one may say a conduction defect caused a cardiac arrest resulting in death.
As time passed by and I witnessed more and more of such phenomena where outcomes were different in spite of receiving the same care, I became intrigued and started to think more seriously about them.
It is with this background that I turned to Dhamma for a possible explanation to this puzzle as the explanations we have been offering have never been up to my satisfaction.
If we are to understand this problem as doctors we need to pay attention to the present Bio Medical health model we follow in western medicine. This doesn’t recognize an interaction between mind and body and is based on the seventeenth century thinking that mind and body are two separate entities with no interaction.
In such a model there is no place for the mind or any other unseen Karma or karmic force to influence the body or bodily functions. This belief perpetuated for nearly three centuries simply because there was no plausible scientific explanation as to how an interaction could exist between mind and body.
But little did we realise that the modern science can grasp only those factors or phenomena perceived by five sensory organs. In such a model we can very well understand and explain how for example, environmental pollution can cause illness and chemicals such as antibiotics can cure infections.
However, based on this model, we cannot explain how a force or an influence such as Karma or spirituality arising in the depth of ones mind, which can neither be seen or grasped, can influence our health.
But with the advent of Quantum Theory in the twentieth century, explaining the dual nature of matter, the materialistic view of the universe too probably changed. This certainly influenced the bio medical health model as well.
The Quantum theory explains how the same matter can exist simultaneously in two different forms, for example as solid or energy form. Initially this was a puzzle even to the best of physicists, but later they came to accept this reality.
It is with this background, towards the end of twentieth century, the medical scientists began to speculate a plausible link between mind and body too. This lead to the recognition of Psycho Neuro Immune Endocrine (PNIE or PNI) system as the link between mind and body.
PNI is a functional system which can explain how mind can influence the body or bodily function. It is a well accepted fact that a woman is more prone to get a breast cancer after her husband’s death.
This can now be explained based on PNI system as a result of lowered immunity in bereavement and depression. So we now have a plausible system to explain the influence of mind on body or physical health.
Meditation is widely believed to cure cancer - probably based on the same mechanism and by enhancing the immune system and engulfing the cancer cells. People who meditate are even less prone to infections such as common cold, again due to the same reason of enhanced immunity.
The challenge we have in this century is to find ways and means of enhancing the power of the mind to cure or heal physical illnesses and meditation certainly seems to be one way.
We now speak of spiritual dimension in health. Health was hitherto defined as physical, mental and social well being. The fourth dimension which is spiritual well-being is now being added to this definition of health, as a result.
This brings to my mind the Buddhist teaching which recognises mind as foremost to everything else. This I consider to be an instance where western medical science at last has recognized religion or religious belief or behavirour as an entity influencing our health.
Acceptance of this truth compels doctors to accommodate patients’ religious beliefs and wishes in matters related to health and disease. This is a truth common to any religion as is now recognised.
As doctors we also encounter birth and death. As death, what we see is only a physical death. When the functional connection between vital organs ceases to exist, we declare someone as dead.
For this purpose, observation of pulse and breathing is adequate. But from Buddhist perspective death is cessation of consciousness (Vinnana). According to modern science, consciousness is said to be in a quantum form.
An electron would remain within an atom only as long as it is moving and similarly our Vinnana or consciousness too can stay within us only as long as our brain cells function. The moment brain cells cease to function as in the physical death we see, Vinnana cannot exist.
But if consciousness or Vinnana is so closely related to the functioning or living cells, is it possible for the reverse to happen? ie. if Vinnana ceases to exist would the brain cells die or a physical death occurs.
As doctors we have never entertained this as a possible mechanism of death. This is because what we have been taught is that mind is an epiphenomenon of biology and not the other way round.
But looking at the fact that Vinnana and functional integrity of the cell are so closely related to each other, who can challenge if one says it is Vinnana that ceases first and this is followed by cell death - after all the two seem so interdependent.
According to Buddhist teaching there is nothing exiting as such, from our bodies at the time of death and that is why the phrase re-becoming is used in place of rebirth. One may then question as to what happens to our consciousness or Vinnana at the time of death.
As much as electronic energy can be transferred or re-manifested in quantum form between different energy levels in this universe, without anything travelling as such in conventional form, it is quite reasonable to assume that our consciousness too could similarly be re-manifested from one energy level in another level without actually anything in conventional form travelling in between.
As said before, for Vinnana or consciousness to re-manifest itself the prerequisite is that there should be functioning or developing brain. This should be none other than in an embryo developing from a fertilized ovum with the appropriate potential.
Was then Sugathadasa’s nephew’s heart attack only a physical manifestation of a more complex process of ceasing of Vinnana as the initial event in the process leading to death. This seems to be the mechanism suggested by Sugathadasa by his attributing the cause of physical death of his nephew to Karma.
His Vinnana or energy potential for life or Karma as understood by Sugathadasa, was probably being transferred or re-manifested in a more sustainable or suitable energy level in the universe as it was no more sustainable in the present life, and this resulted in his physical death as we doctors see.
If that was the case no amount of effort from us could have sustained his life. As a doctor caring for heart patients, I have experienced this type of situations repeatedly in my professional life - same care given to two patients, yet one dies and the other survives for no obvious reason.
Ironically sometimes the one we think would survive, is not the one who survives and vice versa. Yet the truth is that the medical teaching I received would not permit me to consider Karma as a cause of death. Medical science therefore need to explore the hitherto unexplained territory of Karma in relation to death and birth if we are to explain situations like this.
This brings us to a still more complex situation. The birth we see as doctors is again more a physical one. The cry of the new born is considered to be the evidence of his life and our responsibility as doctors in attendance at the delivery of a baby is, to a great extent relieved when that happens.
Because then we know the functional integrity between the vital organs is established and the life has started. We would not consider this birth as a re-becoming of the energy or Karma from a previous life.
We ascertain life of a fetus in uterus only from its reactions to stimuli and functioning of organs such as heartbeat. Here again, if one argues that it is Vinnana or Karma that should come first for the life to begin or both Vinnana and cell function should occur simultaneously, nobody would be able to challenge.
Again as doctors, we look for physical manifestation to define the beginning of life as much as we did with death. Therefore as doctors our approach to both death and life is very mechanistic and superficial looking at them only as mere biological events. Interestingly however, one is born with a set of genes or biological material which is unique to that particular individual.
We know genes are essential for sustaining life as many functions of life are dependent on genes. With the mapping of the human genome, genes have come to the forefront in our understanding of diseases and developing new treatment modalities. A genetic basis is now being attributed to more and more diseases and biological processes in the body.
Based on the science we know of, one can understand genes influencing the bodily functions. For instance, they encode or mediate in the synthesis of vital hormones or enzymes in the body. But what we fail to understand is why then no two genomes are alike.
Why should they be different from each other if they are to perform the same functions in the human body? That seems beyond our comprehension from scientific viewpoint.
As doctors we know that one’s genetic makeup determines a lot of things in life. Not only physical growth, but the behaviour, talents and sometimes diseases and even the cause of death is decided by our genes.
Some genes called dominant genes when present will invariably have their influence on life whereas the effect of some other genes can be masked by the presence of another more influential gene or even environmental factors. This seems to have some strange similarity to Karma as I learned in Dhamma school.
Some Karma or actions we do will invariably produce results in the next birth while some Karma can get cancelled off, I was taught. Is it these Karma from our previous life that masquerade as genes at birth and influence our lives thereafter?
This is the question which keeps coming to my mind when ever I compare the way Karma is supposed to influence a person and the way genes play their role in life. One difference of course is, that genes but not Karma can be seen as tiny solid nodules on the chromosomes under the electron microscope.
If they were the same, can Karma appear as solid matter under a microscope?. The Quantum Theory can probably explain this based on dual nature of matter.
Therefore, if one now argues that genes are actually our Karma, there is very little ground to oppose such a view. What we see as solid nodules could be condensed forms of energy or Karma, one may say.
If genes are manifestations of Karma from the previous births, Sugathadasa may well be correct in his explanation of his nephew’s death as due to Karma - after all it may be his genetic make up that made him vulnerable to death from the heart attack.
As modern medical science is attributing more and more of the control of life to one’s genetic make up who can say with any confidence that Sugathadasa’s explanation was unscientific.
What are the implications from this story to us as practicing doctors? We need to rethink the mechanistic approach to birth, death and disease. In the light of spirituality being recognized as influencing our health we need to develop a newer Medico Spiritual health model.
Such a model would accommodate hitherto unrecognized forces which may be controlling our destiny. Genes with ever increasing roles being attributed can be looked upon as manifestations of these unforeseen forces which I myself would like to call Karma. A Medico Spiritual health model would pave the way to harness the power of mind for better health during this life and probably in the life after.
Originally published to The Ceylon Daily News April 2007
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